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Kentish-Barnes N, Chevret S, Valade S, Jaber S, Kerhuel L, Guisset O, Martin M, Mazaud A, Papazian L, Argaud L, Demoule A, Schnell D, Lebas E, Ethuin F, Hammad E, Merceron S, Audibert J, Blayau C, Delannoy PY, Lautrette A, Lesieur O, Renault A, Reuter D, Terzi N, Philippon-Jouve B, Fiancette M, Ramakers M, Rigaud JP, Souppart V, Asehnoune K, Champigneulle B, Goldgran-Toledano D, Dubost JL, Bollaert PE, Chouquer R, Pochard F, Cariou A, Azoulay E. A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial. Lancet 2022; 399:656-664. [PMID: 35065008 DOI: 10.1016/s0140-6736(21)02176-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND In relatives of patients dying in intensive care units (ICUs), inadequate team support can increase the prevalence of prolonged grief and other psychological harm. We aimed to evaluate whether a proactive communication and support intervention would improve relatives' outcomes. METHODS We undertook a prospective, multicentre, cluster randomised controlled trial in 34 ICUs in France, to compare standard care with a physician-driven, nurse-aided, three-step support strategy for families throughout the dying process, following a decision to withdraw or withhold life support. Inclusion criteria were relatives of patients older than 18 years with an ICU length of stay 2 days or longer. Participating ICUs were randomly assigned (1:1 ratio) into an intervention cluster and a control cluster. The randomisation scheme was generated centrally by a statistician not otherwise involved in the study, using permutation blocks of non-released size. In the intervention group, three meetings were held with relatives: a family conference to prepare the relatives for the imminent death, an ICU-room visit to provide active support, and a meeting after the patient's death to offer condolences and closure. ICUs randomly assigned to the control group applied their best standard of care in terms of support and communication with relatives of dying patients. The primary endpoint was the proportion of relatives with prolonged grief (measured with PG-13, score ≥30) 6 months after the death. Analysis was by intention to treat, with the bereaved relatives as the unit of observation. The study is registered with ClinicalTrials.gov, NCT02955992. FINDINGS Between Feb 23, 2017, and Oct 8, 2019, we enrolled 484 relatives of ICU patients to the intervention group and 391 to the control group. 379 (78%) relatives in the intervention group and 309 (79%) in the control group completed the 6-month interview to measure the primary endpoint. The intervention significantly reduced the number of relatives with prolonged grief symptoms (66 [21%] vs 57 [15%]; p=0·035) and the median PG-13 score was significantly lower in the intervention group than in the control group (19 [IQR 14-26] vs 21 [15-29], mean difference 2·5, 95% CI 1·04-3·95). INTERPRETATION Among relatives of patients dying in the ICU, a physician-driven, nurse-aided, three-step support strategy significantly reduced prolonged grief symptoms. FUNDING French Ministry of Health.
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Affiliation(s)
- Nancy Kentish-Barnes
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France.
| | - Sylvie Chevret
- Department of Biostatistics and Medical Information, UMR 1153, ECSTRRA Team, INSERM, Paris University, Saint Louis Hospital, AP-HP, Paris, France
| | - Sandrine Valade
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; AP-HP Centre, Cochin Hospital, Medical Intensive Care, Paris, France
| | - Samir Jaber
- Saint Eloi University Hospital, Department of Anesthesia and Critical Care Medicine, Montpellier and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Lionel Kerhuel
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Olivier Guisset
- Saint André University Hospital, Medical Intensive Care, Bordeaux, France
| | - Maëlle Martin
- Hôtel Dieu University Hospital, Medical Intensive Care, Nantes, France
| | - Amélie Mazaud
- Hospices Civils de Lyon, Edouard Herriot University Hospital, Surgical Intensive Care, Lyon, France
| | - Laurent Papazian
- AP-HM, Hôpital Nord, Medical Intensive Care and Aix-Marseille University, Faculté des Sciences Médicales et Paramédicales, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Marseille, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Edouard Herriot Hospital, Medical Intensive Care, and Université de Lyon, Lyon, France
| | - Alexandre Demoule
- AP-HP Sorbonne Université, La Pitié-Salpêtrière University Hospital, Medical Intensive Care Unit and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - David Schnell
- Angoulême Hospital, Medical and Surgical Intensive Care, Angoulême, France
| | - Eddy Lebas
- Bretagne Atlantique Hospital, Medical and Surgical Intensive Care, Vannes, France
| | - Frédéric Ethuin
- Côte de Nacre University Hospital, Surgical Intensive Care, Caen, France
| | - Emmanuelle Hammad
- AP-HM, Hospital Nord, Anaesthesia and Intensive Care, Marseille, France
| | - Sybille Merceron
- André Mignot Hospital, Medical Intensive Care, Le Chesnay, France
| | - Juliette Audibert
- Louis Pasteur Hospital, Medical and Surgical Intensive Care, Chartres, France
| | - Clarisse Blayau
- AP-HP Sorbonne University, Tenon Hospital, Medical Intensive Care, Paris, France
| | | | - Alexandre Lautrette
- Gabriel Montpied University Hospital, Medical Intensive Care, Clermont Ferrand, France
| | - Olivier Lesieur
- La Rochelle Hospital, Medical and Surgical Intensive Care, La Rochelle, France
| | - Anne Renault
- Cavale Blanche University Hospital, Medical Intensive Care, Brest, France
| | - Danielle Reuter
- Sud Francilien Hospital, Medical and Surgical Intensive Care, Evry, France
| | - Nicolas Terzi
- Grenoble Alpes University Hospital, Medical Intensive Care, Grenoble, France
| | | | - Maud Fiancette
- Les Oudairies Hospital, Medical and Surgical Intensive Care, La Roche-sur-Yon, France
| | - Michel Ramakers
- Saint Lô Hospital, Medical and Surgical Intensive Care, Saint Lô, France
| | | | - Virginie Souppart
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Karim Asehnoune
- Hôtel Dieu University Hospital, Department of Anesthesia and Critical Care, Nantes, France
| | - Benoît Champigneulle
- AP-HP Centre, Hôpital Européen Georges Pompidou, Department of Aaesthesia and Critical Care, Paris, France
| | | | - Jean-Louis Dubost
- René Dubos Hospital, Medical and Surgical Intensive Care, Pontoise, France
| | | | - Renaud Chouquer
- Annecy Hospital, Medical and Surgical Intensive Care, Annecy, France
| | - Frédéric Pochard
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; AP-HP Nord, Fernand Widal Hospital, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Alain Cariou
- AP-HP Centre, Cochin Hospital, Medical Intensive Care, Paris, France; Paris University, Paris, France
| | - Elie Azoulay
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France; Department of Biostatistics and Medical Information, UMR 1153, ECSTRRA Team, INSERM, Paris University, Saint Louis Hospital, AP-HP, Paris, France
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Lazaar S, Mazaud A, Delsuc C, Durand M, Delwarde B, Debord S, Hengy B, Marcotte G, Floccard B, Dailler F, Chirossel P, Bureau-Du-Colombier P, Berthiller J, Rimmelé T. Ultrasound guidance for urgent arterial and venous catheterisation: randomised controlled study. Br J Anaesth 2021; 127:871-878. [PMID: 34503827 DOI: 10.1016/j.bja.2021.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/02/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Haemodynamically unstable patients often require arterial and venous catheter insertion urgently. We hypothesised that ultrasound-guided arterial and venous catheterisation would reduce mechanical complications. METHODS We performed a prospective RCT, where patients requiring both urgent arterial and venous femoral catheterisation were randomised to either ultrasound-guided or landmark-guided catheterisation. Complications and characteristics of catheter insertion (procedure duration, number of punctures, and procedure success) were recorded at the time of insertion (immediate complications). Late complications were investigated by ultrasound examination performed between the third and seventh days after randomisation. Primary outcome was the proportion of patients with at least one mechanical complication (immediate or late), by intention-to-treat analysis. Secondary outcomes included success rate, procedure time, and number of punctures. RESULTS We analysed 136 subjects (102 [75%] male; age range: 27-62 yr) by intention to treat. The proportion of subjects with one or more complications was lower in 22/67 (33%) subjects undergoing ultrasound-guided catheterisation compared with landmark-guided catheterisation (40/69 [58%]; odds ratio: 0.35 [95% confidence interval: 0.18-0.71]; P=0.003). Ultrasound-guided catheterisation reduced both immediate (27%, compared with 51% in the landmark approach group; P=0.004) and late (10%, compared with 23% in the landmark approach group; P=0.047) complications. Ultrasound guidance also reduced the proportion of patients who developed deep vein thrombosis (4%, compared with 22% following landmark approach; P=0.012), and achieved a higher procedural success rate (96% vs 78%; P=0.004). CONCLUSIONS An ultrasound-guided approach reduced mechanical complications after urgent femoral arterial and venous catheterisation, while increasing procedural success. CLINICAL TRIAL REGISTRATION NCT02820909.
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Affiliation(s)
- Stephen Lazaar
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France.
| | - Amélie Mazaud
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Claire Delsuc
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Maeva Durand
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Benjamin Delwarde
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Sophie Debord
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Baptiste Hengy
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Guillaume Marcotte
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Bernard Floccard
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France
| | - Frédéric Dailler
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Pierre Wertheimer Hospital, Lyon, France
| | - Pierre Chirossel
- Hospices Civils de Lyon, Department of Vascular Explorations, Louis Pradel Hospital, Lyon, France
| | | | - Julien Berthiller
- Hospices Civils de Lyon, Epidemiology, Pharmacology and Clinical Investigations, Lyon, France
| | - Thomas Rimmelé
- Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Lyon, France; EA7426 Pathophysiology of Injury-Induced Immunosuppression, PI3, Hospices Civils de Lyon-Biomérieux-University Claude Bernard Lyon 1, Lyon, France
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